Provider Demographics
NPI:1336897677
Name:OPTIMAL CARE PHARMACY
Entity Type:Organization
Organization Name:OPTIMAL CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAINAINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:208-440-3512
Mailing Address - Street 1:2937 S BAY STAR WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3094
Mailing Address - Country:US
Mailing Address - Phone:208-440-3512
Mailing Address - Fax:
Practice Address - Street 1:9428 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8101
Practice Address - Country:US
Practice Address - Phone:208-590-7553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy